Original articleClinical analysis of 95 cases of pulmonary sarcomatoid carcinoma
Introduction
Sarcomatoid carcinomas are a rare type of cancer found in the lung and other organs. Primary pulmonary sarcomatoid carcinoma (PSC) constitutes about 0.1-0.4% of all lung cancers [1], [2]. PSC is a non-small cell lung cancer containing poorly differentiated cells and sarcoma or sarcomatoid components (spindle and/or giant cells). According to the WHO classification published in 2004, PSC includes five subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma (PB) [3]. Because of its rarity, heterogeneity, and pleomorphism [4], PSC is poorly understood, and there have been few reports describing it. We present 95 patients with PSC who were treated at the Shanghai Chest Hospital between September 24, 2008 and June 3, 2014. Clinical characteristics, pathohistological presentation, patient survival, and prognostic factors of this disease are reviewed.
Section snippets
Materials
95 patients were hospitalized at the Shanghai Chest Hospital for the treatment of pulmonary sarcomatoid carcinoma (PSC) from September 24, 2008 to June 3, 2014. Their disease was confirmed by pathologic analysis. Patient gender and age, smoking history, time of first diagnosis, diagnostic methods, tumor location, pathohistological subtype, tumor size, TNM stage, immunohistochemistry results, subsequent treatments, and patient survival were retrospectively reviewed. Pathohistologic diagnosis of
Results
88 patients underwent surgical treatment. Pathologic analysis of the resected tissues confirmed the diagnosis of PSC. 81 patients underwent lobectomy, three underwent total lung resection, and four underwent tumor excision. Six patients had a CT-guided lung biopsy and one a supraclavicular lymph node biopsy to confirm the diagnosis of PSC. The disease was more common in men and smokers. 39 (41.1%) patients had no history of smoking, but the other 56 (58.9%) patients were long-term smokers.
Discussion
Pulmonary sarcomatoid carcinoma (PSC) is a rare type of lung cancer. Except for pediatric pulmonary blastoma, other subtypes of pulmonary sarcomatoid carcinoma mainly occur in men over 60 years and in smokers. There is a male to female ratio of approximately 4:1 [2], [5], [6], [7]. Lin et al. [8] reported 69 cases of PSC with a male to female ratio of 3.6:1. The present study included 80 male patients and only 15 female patients, giving a male to female ratio of 5.3:1. The discrepancy between
Conclusion
Pulmonary sarcomatoid carcinoma has a low incidence, unspecific clinical presentation, and a poor prognosis. The main treatment is surgical excision as chemotherapy is not effective and there are no targeted drugs, cancer vaccines, or cancer immunotherapy drugs for this disease. Further studies with larger cohorts are needed to better understand this disease.
Conflict of interest
We all declare that we have no conflict of interest.
Acknowledgements
The work was sponsored by no foundation.
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These authors contributed equally to this work and should be regarded as co-first authors.